查詢結果分析
來源資料
頁籤選單縮合
題名 | 針灸對腦中風療效評估之實證研究及文獻回顧=The Assessment of the Effects of Acupuncture Therapy on Stroke Patients: Evidence-based Research and Literature Review |
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作者 | 林昭庚; Lin, Jaung-geng; |
期刊 | 中醫藥年報 |
出版日期 | 20141200 |
卷期 | 3 2014.12[民103.12] |
頁次 | 頁(24)1-(24)136 |
分類號 | 413.91 |
語文 | chi |
關鍵詞 | 針灸; 腦中風; 二次中風; 實證醫學; Acupuncture; Stroke; Recurrent stroke; Evidence-based medicine; |
中文摘要 | 研究背景:腦中風是全球主要死因之一,有很高的復發率,五年內為 35.3%,十年內為 51.3%,是成人殘障的主要致因。為加強中風病人中醫醫療照護, 2010年起腦血管疾病病患之中醫門診及西醫住院中醫會診之特別照護計畫全面納入全民健保給付範圍。中醫運用針灸已經超過 2500年的歷史,並且廣泛應用於中風的治療。現今中醫政策或醫療體系之推行,實證數據之有效與否便成為關鍵。因此,若可以過去針灸治療腦中風療效評估作成一份綜合評估的文獻回顧研究,將有助於中醫針灸實證醫學的發展。 研究目的:本研究利用全民健康保險研究資料庫,探討:(1)台灣中風病人中醫醫療利用及其相關因子,(2)以二次中風等指標評估針灸治療腦中風療效評估並探討其影響因子。本研究也同時針對針灸治療腦中風實證醫學文獻進行評讀。 研究方法:本研究施行步驟分為三個部份,第一部份及第二部分為台灣中風病人中醫醫療利用及其相關因子之分析研究,及針灸對腦中風療效評估之實證研究,分別使用國家衛生研究院所提供之健保資料庫 2005年及 2000年之百萬歸人檔分析,第三部份為針灸對腦中風療效之實證醫學文獻評讀。 結果:利用健保資料庫 2005年百萬歸人檔分析結果顯示,針灸使用次數高者相對於使用次數低及未使用者其中風復發率較低,其風險分別為 0.56、0.65及 1.00。在性別部分,女性做針灸的療效優於男性;而同為針灸使用次數多者,老年人中風的復發率之風險比為 0.52,高於 20-44歲之 0.13。在中風後使用針灸、藥物、復健或三種皆未使用者,其中風復發的發生率分別為每千人 0.27、0.50、0.91及1.00;使用健保資料庫 2000年百萬歸人檔分析結果與 2005年之結果大致相同。有關實證醫學文獻結果顯示針刺治療對中風後急性期和亞急性期的失眠、肌肉的痙攣及強度有產生明顯的改善;對認知與情緒、生活品質 ADL則影響不顯著。對慢性期吞嚥、平衡、認知可產生明顯的改善;對生活品質、肌肉的痙攣,根據不同的機構所做的報告成效不一,但多數的報告是有效的。而灸法治療對泌尿系統恢復程度有明顯的改善。 結論:針灸可以有效減少中風復發,此種治療方式對於年輕的患者療效更為顯著,而使用次數愈多其預防效果更好。 |
英文摘要 | BACKGROUND: Stroke is one of leading causes of death worldwide. The five-year and ten-year rate of recurrent stroke are 35.3% and 51.3%, respectively. Stroke is also the leading cause of disability. To enhance the medical care of traditional Chinese Medicine (TCM) for stroke patients, the special care plan of TCM for stroke patients was implemented in the National Health Insurance since 2010. Acupuncture treatment was used to care stroke patients commonly among people in Taiwan and other Asian countries. The effectiveness of evidenced-based research is the key point to perform TCM policy and medical system. Therefore, we need a systematic review assessing the effectiveness of acupuncture on stroke patients. We also need evidence to support the association between acupuncture treatment and reduced risk of recurrent stroke. AIM: The purpose of this study included: (1) To report the current status of TCM use in stroke patients. (2) To investigate the association between acupuncture treatment and risk of recurrent stroke. (3) To complete the review of the effectiveness of acupuncture treatment on stroke patients. METHOD: Our study included three parts: (1) Factors associated with TCM use in stroke patients: We collected information from NHRID to investigate TCM use for new-onset stroke patients between 2000 and 2002. TCM use was defined as stroke patient who used TCM services within one year after stroke. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for factors associated with TCM use in multiple logistic regressions. (2) We identified 5589 newly diagnosed stroke patients in 2000-2002 from the Taiwan National Health Insurance database. The incidence rates and hazards of stroke recurrence in these patients by the end of 2007 were compared according to the acupuncture treatment status, namely none, low-and high-intensity sers. The interactions between acupuncture, pharmacological treatment and rehabilitation were also measured. (3) We used PubMed search engine to collected references regarding the effectiveness of acupuncture treatment for stroke patients. The searching keywords were limited in “stroke, acupuncture, randomized clinical trial” and “cerebrovascular, acupuncture, randomized clinical trial”. We collected references that published in 2004-2011. RESULTS: (1) The first-year rate of TCM use for stroke patients was 32.3%. Female, younger age, recurrent stroke, history of diabetes, living in high-urbanized area and low income were factors associated with TCM use among new-onset stroke patients. (2) In the seven-year follow-up period, stroke patient with acupuncture treatment had ilower risk of recurrent stroke compared with those without acupuncture treatment (HR=0.60, 95%CI=0.52-0.70). Our results showed the dose-response relationship between the intensity of acupuncture treatment and reduced risk of stroke. (3) Our systematic review showed that acupuncture improves insomnia, spastic hypertonia, but does not improve cognition and quality of life in patients with acute and subcute stroke. During the chronic period, acupuncture improves dysphagia, balance, cognition for stroke patients. Although the beneficial effects of acupuncture on quality of life, spasticity remained controversial, the majority of previous studies still indicted the positive effects. Moxibustion is also effective to post-stroke urinary symptoms. CONCLUSION: The first-year TCM use after new-onset stroke is as high as 32.3%. Stroke patients used acupuncture had reduced risk of recurrent stroke. Overall, the systematic review suggested acupuncture treatment is beneficial for stroke patients. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。